Acute Compartment Syndrome from Spontaneous Intramuscular Hemorrhage in the Setting of Converging Hemostatic Risk Factors: A Case Report.
- 1Texas A&M College of Medicine at Willowbrook, Houston, Texas, USA.
- 2Houston Methodist Willowbrook, Houston, Texas, USA.
Abstract
Acute compartment syndrome secondary to spontaneous intramuscular hemorrhage is an uncommon but limb-threatening complication of anticoagulation. Severe hemorrhagic complications during anticoagulation are frequently multifactorial. Yet, clinical attention often focuses narrowly on anticoagulant transition timing rather than the full burden of concurrent hemostatic risk factors an orthopedic surgeon must weigh when managing these patients surgically. A 50-year-old male with prior deep venous thrombosis (DVT), coronary artery disease, long-term exogenous testosterone use, and a personal history of prolonged post-dental bleeding presented with acute left calf pain and was diagnosed with popliteal DVT. He received enoxaparin 90 mg subcutaneously (one dose) and was prescribed rivaroxaban 15 mg twice daily; he also continued aspirin 81 mg daily, fish oil, and high-dose cayenne pepper supplementation. Approximately 13 h after enoxaparin and 1 h after his first rivaroxaban dose, he returned with worsening pain. Imaging revealed a rapidly expanding intramuscular hematoma progressing to acute compartment syndrome, necessitating emergent four-compartment fasciotomy and reoperation for diffuse soft-tissue hemorrhage without a discrete vascular source. At least six concurrent patient-intrinsic hemostatic risk factors were identified: antiplatelet therapy, platelet-modifying supplementation, exogenous testosterone with potential pharmacokinetic interaction, testosterone-associated erythrocytosis, mildly reduced renal clearance, and a personal bleeding history consistent with an incompletely evaluated bleeding diathesis. The same outcome could plausibly have resulted from rivaroxaban alone. Orthopedic surgeons managing anticoagulated patients should conduct systematic, individualized hemostatic risk assessment rather than focusing narrowly on anticoagulant transition timing.
Related
- An automated, explainable, NCCT-based clinical decision-support system for spontaneous intracerebral hemorrhage.
- Admission White Blood Cell Count and Neutrophil‐to‐Lymphocyte Ratio for Early Risk Stratification after Spontaneous Intracerebral Hemorrhage: A Retrospective Cohort Study
- Spontaneous Renal Hemorrhage Secondary to MRSA Renal Abscess Requiring Nephrectomy After Failed Percutaneous Drainage: A Case Report.
- First-in-Human Phase 1b/2a Trial Shows Safety with MEK 1/2 Inhibitor EDV2209 as A Novel Treatment for Spontaneous Subarachnoid Hemorrhage.
- Endoscopic evacuation of spontaneous intracerebral hemorrhage: Surgical outcomes and prognostic factors.
BibTeX
@article{griffin2026acute,
title = {{Acute Compartment Syndrome from Spontaneous Intramuscular Hemorrhage in the Setting of Converging Hemostatic Risk Factors: A Case Report.}},
author = {Jade Griffin and Daniel Komlos},
journal = {Journal of orthopaedic case reports},
year = {2026},
month = nov,
doi = {10.13107/jocr.2026.v16.i11.8434},
url = {https://europepmc.org/article/MED/42997117},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Acute Compartment Syndrome from Spontaneous Intramuscular Hemorrhage in the Setting of Converging Hemostatic Risk Factors: A Case Report.
AU - Jade Griffin
AU - Daniel Komlos
PY - 2026
DA - 2026/11/01
JO - Journal of orthopaedic case reports
DO - 10.13107/jocr.2026.v16.i11.8434
UR - https://europepmc.org/article/MED/42997117
AB - Acute compartment syndrome secondary to spontaneous intramuscular hemorrhage is an uncommon but limb-threatening complication of anticoagulation. Severe hemorrhagic complications during anticoagulation are frequently multifactorial. Yet, clinical attention often focuses narrowly on anticoagulant transition timing rather than the full burden of concurrent hemostatic risk factors an orthopedic surgeon must weigh when managing these patients surgically. A 50-year-old male with prior deep venous thrombosis (DVT), coronary artery disease, long-term exogenous testosterone use, and a personal history of prolonged post-dental bleeding presented with acute left calf pain and was diagnosed with popliteal DVT. He received enoxaparin 90 mg subcutaneously (one dose) and was prescribed rivaroxaban 15 mg twice daily; he also continued aspirin 81 mg daily, fish oil, and high-dose cayenne pepper supplementation. Approximately 13 h after enoxaparin and 1 h after his first rivaroxaban dose, he returned with worsening pain. Imaging revealed a rapidly expanding intramuscular hematoma progressing to acute compartment syndrome, necessitating emergent four-compartment fasciotomy and reoperation for diffuse soft-tissue hemorrhage without a discrete vascular source. At least six concurrent patient-intrinsic hemostatic risk factors were identified: antiplatelet therapy, platelet-modifying supplementation, exogenous testosterone with potential pharmacokinetic interaction, testosterone-associated erythrocytosis, mildly reduced renal clearance, and a personal bleeding history consistent with an incompletely evaluated bleeding diathesis. The same outcome could plausibly have resulted from rivaroxaban alone. Orthopedic surgeons managing anticoagulated patients should conduct systematic, individualized hemostatic risk assessment rather than focusing narrowly on anticoagulant transition timing.
SN - 2250-0685
SN - 2321-3817
ER -